Burns

first degree burns

epidermis

• red/reddish brown, peeling, itchy, relieved with cooling, blanches

• ex) sunburn

second degree burns

epidermis and portion of dermis

• painful with blisters, some weeping/edema

• ex) scalding water

third degree burns

total destruction of epidermis, dermis, and some underlying tissue

• lack of sensation, dry skin, pale/white, leathery, edema

• grafting needed

• ex) chemical, fires

fourth degree

deep tissue, muscle, and bone involvement

• charred color

• amputations likely

• ex) prolonged burns or high voltage shock

rule of 9s

• head/neck = 9%

• each arm = 9%

• anterior chest = 18%

• posterior ab = 18%

• each leg = 18%

• peri = 1%

pulmonary burns s/sx

• upper airway: severe edema

• lower airway: mucosal edema, bronchospasm, atelectasis

• general: singed nasal hairs, facial erythema, edema, tachypnea, dyspnea, hoarseness, brassy cough, expectoration of carbon, stridor

pulmonary burns tx

monitor ABGs (elevated CO2, decreased O2, decreased O2 sat), intubation, O2 100% via nonrebreather

emergent burn assessment

ABCDE → airway, breathing, circulation, disability (neuro deficit), exposure/examine (TBSA)

emergent burn tx

• actions → vitals q 1 hr, o2 at 100%, foley, NGT, large bore IV, fluids (lactated ringers), IV analgesia in small frequent doses

• fluids!! (greatest loss first 24-36 hours) → replace electrolytes (hyponatremia, hypomagnesemia, hyperkalemia)

emergent burn labs

• elevated Hct (loss of blood plasma)

• decreased clotting (prothrombin time prolonged)

acute/intermediate

• F/E balance → causes hemodilation, increased u/o, hyponatremia

• decreased GI motility and kidney function

• pain mmt → NSAIDS, opioids, benz

• wound care → mild non-scented soap/water, topical antibacterial therapy (Silvadene), dry dressing w/ sterile saline

frostbite

remove from cold, administer pain meds, immerse in warm water, apply loose/sterile/bulky dressing, monitor for compartment syndrome

types of debridement

• natural: tissue separates spontaneously

• mechanical: tools used to manually separate the eschar

• chemical: topical enzymes involved

• surgical: done early; best if covered with skin graft after; wound bed must be moist for healing